Crash of a Piper PA-31-350 Navajo Chieftain in North Las Vegas: 1 killed

Date & Time: Aug 28, 2008 at 1238 LT
Operator:
Registration:
N212HB
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
North Las Vegas - Palo Alto
MSN:
31-8152072
YOM:
1981
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
3195
Captain / Total hours on type:
100.00
Aircraft flight hours:
6373
Circumstances:
During climb a few minutes after takeoff, a fire erupted in the airplane's right engine compartment. About 7 miles from the departure airport, the pilot reversed course and notified the air traffic controller that he was declaring an emergency. As the pilot was proceeding back toward the departure airport witnesses observed fire beneath, and smoke trailing from, the right engine and heard boom sounds or explosions as the airplane descended. Although the pilot feathered the right engine's propeller, the airplane's descent continued. The 12-minute flight ended about 1.25 miles from the runway when the airplane impacted trees and power lines before coming to rest upside down adjacent to a private residence. A fuel-fed fire consumed the airframe and damaged nearby private residences. The airplane was owned and operated by an airplane broker that intended to have it ferried to Korea. In preparation for the overseas ferry flight, the airplane's engines were overhauled. Maintenance was also performed on various components including the engine-driven fuel pumps, turbochargers, and propellers. Nacelle fuel tanks were installed and the airplane received an annual inspection. Thereafter, the broker had a ferry pilot fly the airplane from the maintenance facility in Ohio to the pilot's Nevada-based facility, where the ferry pilot had additional maintenance performed related to the air conditioner, gear door, vacuum pump, and idle adjustment. Upon completion of this maintenance, the right engine was test run for at least 20 minutes and the airplane was returned to the ferry pilot. During the following month, the ferry pilot modified the airplane's fuel system by installing four custom-made ferry fuel tanks in the fuselage, and associated plumbing in the wings, to supplement the existing six certificated fuel tanks. The ferry pilot held an airframe and powerplant mechanic certificate with inspection authorization. He reinspected the airplane, purportedly in accordance with the Piper Aircraft Company's annual inspection protocol, signed the maintenance logbook, and requested Federal Aviation Administration (FAA) approval for his ferry flight. The FAA reported that it did not process the first ferry pilot's ferry permit application because of issues related to the applicant's forms and the FAA inspector's workload. The airplane broker discharged the pilot and contracted with a new ferry pilot (the accident pilot) to immediately pick up the airplane in Nevada and fly it to California, the second ferry pilot's base. The contract specified that the airplane be airworthy. In California, the accident pilot planned to complete any necessary modifications, acquire FAA approval, and then ferry the airplane overseas. The discharged ferry pilot stated to the National Transportation Safety Board (NTSB) investigator that none of his airplane modifications had involved maintenance in the right engine compartment. He also stated that when he presented the airplane to the replacement ferry pilot (at most 3 hours before takeoff) he told him that fuel lines and fittings in the wings related to the ferry tanks needed to be disconnected prior to flight. During the Safety Board's examination of the airplane, physical evidence was found indicating that the custom-made ferry tank plumbing in the wings had not been disconnected. The airplane wreckage was examined by the NTSB investigation team while on scene and following its recovery. Regarding both engines, no evidence was found of any internal engine component malfunction. Notably, the localized area surrounding and including the right engine-driven fuel pump and its outlet port had sustained significantly greater fire damage than was observed elsewhere. According to the Lycoming engine participant, the damage was consistent with a fuel-fed fire originating in this vicinity, which may have resulted from the engine's fuel supply line "B" nut being loose, a failed fuel line, or an engine-driven fuel pumprelated leak. The fuel supply line and its connecting components were not located. The engine-driven fuel pump was subsequently examined by staff from the NTSB's Materials Laboratory. Noted evidence consisted of globules of resolidified metal and areas of missing material consistent with the pump having been engulfed in fire. The staff also examined the airplane. Evidence was found indicating that the fire's area of origin was not within the wings or fuselage, but rather emanated from a localized area within the right engine compartment, where the engine-driven fuel pump and its fuel supply line and fittings were located. However, due to the extensive pre- and post-impact fires, the point of origin and the initiating event that precipitated the fuel leak could not be ascertained. The airplane's "Pilot Operator's Handbook" (POH), provides the procedures for responding to an in-flight fire and securing an engine. It also provides single-engine climb performance data. The POH indicates that the pilot should move the firewall fuel shutoff valve of the affected engine to the "off" position, feather the propeller, close the engine's cowl flaps to reduce drag, turn off the magneto switches, turn off the emergency fuel pump switch and the fuel selector, and pull out the fuel boost pump circuit breaker. It further notes that unless the boost pump's circuit breaker is pulled, the pump will continuously operate. During the wreckage examination, the Safety Board investigators found evidence indicating that the right engine's propeller was feathered. However, contrary to the POH's guidance, the right engine's firewall fuel shutoff valve was not in the "off" position, the cowl flaps were open, the magneto switches were on, the emergency fuel pump switches and the fuel selector were on, and the landing gear was down. Due to fire damage, the position of the fuel boost pump circuit breaker could not be ascertained. Calculations based upon POH data indicate that an undamaged and appropriately configured airplane flying on one engine should have had the capability to climb between 100 and 200 feet per minute and, at a minimum, maintain altitude. Recorded Mode C altitude data indicates that during the last 5 minutes of flight, the airplane descended while slowing about 16 knots below the speed required to maintain altitude.
Probable cause:
A loss of power in the right engine due to an in-flight fuel-fed fire in the right engine compartment that, while the exact origin could not be determined, was likely related to the right engine-driven fuel pump, its fuel supply line, or fitting. Contributing to the accident was the pilot's failure to adhere to the POH's procedures for responding to the fire and configuring the airplane to reduce aerodynamic drag.
Final Report:

Crash of a Piper PA-31-310 Navajo in Tukums: 1 killed

Date & Time: Aug 16, 2008 at 1030 LT
Type of aircraft:
Operator:
Registration:
YL-CCX
Flight Type:
Survivors:
Yes
Schedule:
Riga - Tukums
MSN:
31-647
YOM:
1970
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
7
Pax fatalities:
Other fatalities:
Total fatalities:
1
Circumstances:
The twin engine aircraft departed Riga on a flight to Tukums with eight people on board to take part to an airshow. Several others aircraft were also en route to Tukums but most of the pilots returned to their departure point due to the deterioration of the weather conditions. On approach to Tukums Airport runway 32, the pilot encountered poor visibility. Unable to establish a visual contact with the runway, he initiated a go-around procedure. After several circuits, he attempted a second approach under VFR mode. Too low, the aircraft struck a hill and eventually crashed in a private garden, coming to rest broken in two. All eight occupants were injured, some seriously. Few hours later, the pilot died from his injuries.

Crash of an Eclipse EA500 in West Chester

Date & Time: Jul 30, 2008 at 1830 LT
Type of aircraft:
Operator:
Registration:
N333MY
Flight Type:
Survivors:
Yes
Schedule:
Philadelphia - West Chester
MSN:
113
YOM:
2007
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
6300
Captain / Total hours on type:
93.00
Aircraft flight hours:
98
Circumstances:
During landing at its home airport, the airplane overran the runway and traveled down a 40-foot embankment before coming to rest against trees and sustaining substantial damage. According to the pilot, his speed on approach was a little fast but he thought it was manageable. Recorded data from the accident airplane revealed that 20 seconds before touchdown, when the pilot selected flaps 30 (landing flaps) the airspeed was approximately 27 knots above the maximum flap extension speed, and as the airplane touched down its airspeed was approximately 14 knots higher than specified for landing. The runway had a displaced threshold with 3,097 feet of runway length available. Skid marks from the accident airplane began approximately 868 feet beyond the displaced threshold, and continued for about 2,229 feet until they left the paved portion of the runway.
Probable cause:
The pilot's failure to obtain the proper touchdown point, and his excessive airspeed on approach.
Final Report:

Crash of a Cessna 414 Chancellor off San Andrés

Date & Time: Jul 26, 2008 at 1052 LT
Type of aircraft:
Registration:
XB-JBD
Flight Type:
Survivors:
Yes
Schedule:
San Salvador – San Andrés – Barranquilla
MSN:
414-0253
YOM:
1971
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
1196
Aircraft flight hours:
4480
Circumstances:
The twin engine aircraft departed San Salvador-Ilopango Airport on a private flight to Barranquilla with an intermediate stop in San Andrés Island, carrying one passenger and one pilot. On final approach to San Andrés-Gustavo Rojas Pinilla Airport runway 06, the left engine failed. The pilot increased power on the right engine but the aircraft continued to lose height. The pilot ditched the aircraft near the coast. Both occupants evacuated safely and were quickly rescued while the aircraft was damaged beyond repair.
Probable cause:
Failure of the left engine on final due to fuel exhaustion. It remained a total of 3 gallons of fuel in the left fuel tank and 23 gallons in the right main tank.
Final Report:

Crash of a Cessna 402B in Ocean Ridge

Date & Time: Jul 22, 2008 at 1350 LT
Type of aircraft:
Registration:
N3990C
Flight Phase:
Flight Type:
Survivors:
Yes
Site:
Schedule:
Lantana - Pompano Beach
MSN:
402B-0857
YOM:
1975
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
1565
Aircraft flight hours:
7222
Circumstances:
The commercial pilot, who was also the former owner of the twin-engine airplane, stated that the purpose of the flight was to reposition the airplane to an airport approximately 22 miles south of the departure airport. Just prior to the flight, he purchased 10 gallons of fuel for each of the two main tanks. The pilot reported that about 5 minutes after takeoff, at an altitude of approximately 1,000 feet, he experienced a "loss of engine power." However, his three separate accounts of the event were inconsistent with respect to which engine had a problem, or the specific nature of the problem. The pilot reported that the airplane started to lose altitude "rapidly," and that he attempted to "wag the wings" in order to "get all the fuel to be useable." The airplane struck a building and terrain approximately 8 miles south of the departure airport. The pilot sustained serious injuries, but there was no fire. Damage to the left engine and propeller was consistent with the engine running at impact, and precluded an attempt to run the left engine in a test cell. Damage to the right engine and propeller was consistent with low or no power at impact. The right engine was subsequently successfully run in a test cell. No evidence of any pre-accident anomalies that could have contributed to the accident was noted with the airframe, engines, or propellers. The fuel selector valve placards did not accurately depict the fuel system configuration. The fuel quantity and its distribution in the tanks, either at the beginning of the flight or at the time of the accident, could not be determined.
Probable cause:
A partial loss of engine power due to fuel starvation. Contributing to the accident was the pilot’s decision to add only a limited amount of fuel prior to the flight, and the fuel selector valve placards' inaccurate depiction of the airplane fuel tank configuration.
Final Report:

Crash of a Cessna 441 Conquest in Sunriver: 1 killed

Date & Time: Jul 16, 2008 at 1015 LT
Type of aircraft:
Operator:
Registration:
N441HK
Flight Type:
Survivors:
No
Schedule:
Bakersfield - Sunriver
MSN:
441-0336
YOM:
1984
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
965
Captain / Total hours on type:
277.00
Aircraft flight hours:
5643
Circumstances:
The pilot was executing a day visual flight rules full-stop landing and touched down on the main landing gear near the approach end of the runway. Soon after the initial touchdown, the airplane became airborne again. Instead of initiating a go-around, the pilot attempted to continue the landing sequence. During that attempt, the airplane bounced on the runway three or four times, each time the rebound back into the air and the runway contact was more severe. During the last contact the airplane impacted the runway with sufficient force to result in the failure of the right main landing gear actuator rod, and in the right propeller contacting the runway surface multiple times. The pilot then initiated a go-around, but since the right engine had failed due to the multiple propeller strikes, the airplane produced asymmetrical thrust and began to roll to the right, veering off the right side of the runway. Soon thereafter its right wing collided with a tree and the airplane impacted terrain in an open field. The airplane was consumed by fire shortly after the collision. Post crash inspection found no evidence of mechanical failure or malfunction with the airframe or either engine.
Probable cause:
The pilot's misjudged landing flare and improper recovery from a bounced landing, and the pilot's failure to maintain directional control during the go-around after one of the airplane's propellers struck the runway.
Final Report:

Crash of a Socata TBM700 in Kennesaw: 1 killed

Date & Time: Jul 15, 2008 at 1457 LT
Type of aircraft:
Operator:
Registration:
N484RJ
Flight Type:
Survivors:
No
Schedule:
Albany - Kennesaw
MSN:
333
YOM:
2005
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
975
Captain / Total hours on type:
44.00
Aircraft flight hours:
398
Circumstances:
During approach to runway 9, the tower controller instructed the pilot to perform an “S” turn 3 miles from the runway. The pilot initiated the “S” turn to the left, and after turning back to the right towards the runway to complete the other half of the turn, the controller advised the pilot that he did not need to finish the maneuver, and could turn onto final approach. The last recorded ground speed was 89 knots when the pilot banked the airplane sharply to the left at this time, witnesses stated that the airplane seemed to do a wing over onto its back and go straight down. Flight simulation tests revealed that while making a steep turn and not adding power, as the bank angle increased the airspeed would decrease and the airplane would enter an aerodynamic stall. Toxicology testing indicated that the pilot had been using tramadol, a prescription painkiller with potentially impairing effects. The pilot had not reported its use on his most recent application for airman medical certificate approximately 20 months prior to the accident. It is unclear what role, if any, the medication or the condition for which it might have been used played in the accident.
Probable cause:
The pilot’s failure to maintain airspeed during final approach resulting in an aerodynamic stall.
Final Report:

Crash of a Piper PA-31T Cheyenne II in Charallave: 3 killed

Date & Time: Jul 2, 2008 at 2321 LT
Type of aircraft:
Registration:
YV-1165
Flight Type:
Survivors:
No
Schedule:
San Cristóbal – Charallave
MSN:
31-7820067
YOM:
1978
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
3
Circumstances:
The twin engine aircraft departed San Cristóbal-Paramillo Airport on a private flight to Charallave with two passengers and one pilot on board. At 2319LT, he was cleared for a VOR-DME approach to runway 10. It was dark but the visibility was about 10 km. Shortly later, another aircraft on approach declared an emergency and became priority. The pilot was instructed to follow a holding pattern when two minutes later, the aircraft struck trees and crashed in a wooded and hilly terrain, bursting into flames. The wreckage was found the following morning 5,5 km northeast of the airport. The aircraft was totally destroyed and all three occupants were killed.
Probable cause:
Given the circumstances in which the accident occurred, it would be considered a CFIT (Controlled Flight Into Terrain) type accident, which occurs as a result of unintentional impact on the ground, when the aircraft is under the control of the pilot in command. It is considered that the most probable cause of the accident was the loss of situational awareness, caused mainly by the concern that he was becoming distracted by the emergency of the aircraft preceding him on the approach, because of his administrative relationship with this aircraft and its crew.
Final Report:

Crash of an Antonov AN-2 in Betz

Date & Time: Jun 15, 2008
Type of aircraft:
Operator:
Registration:
F-AZHB
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Lille - Lognes
MSN:
173 473 09
YOM:
1957
Location:
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
En route from Lille-Lesquin to Lognes-Emerainville Airport, the pilot encountered engine problems and elected to make an emergency landing in a field located in Betz, about 45 km northeast of Lognes. On touchdown, the aircraft sank into muddy field, overturned and came to rest upside down. All four occupants were rescued, among them a passenger was slightly injured. The aircraft was damaged beyond economical repair and was later cannibalised.
Probable cause:
Engine failure for unknown reasons.

Crash of a Beechcraft C90B King Air in Contadora Island

Date & Time: Jun 6, 2008
Type of aircraft:
Registration:
HP-1635
Flight Type:
Survivors:
Yes
Schedule:
Panama City - Contadora Island
MSN:
LJ-1663
YOM:
2002
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
5
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
The twin engine aircraft departed Panama City-Marcos A. Gelabert Airport at 0734LT on a private flight to Contadora Island with five passengers and one pilot on board. Following an uneventful flight, the aircraft landed on wet runway 35. It skidded then veered off runway to the left and came to rest in bushes. All six occupants escaped uninjured while the aircraft was damaged beyond repair.